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    Perforated eardrum + infection + hearing loss
    SteveYYZ posted:
    I saw a couple related postings, but didn't see the answer I wanted so I'm posting separately.

    My eardrum became perforated 21 days ago due to a pretty bad middle ear infection. Throughout my life, I've had bad sinus congestion and occasionally one or both of my ears would become 'clogged', so I didn't think anything of it this time.

    It started bleeding for a few minutes and the loss of hearing + ringing was pretty instant. Urgent care said that my eardrum had perforated and to follow up with an ENT. I was given amox-clav 875mg, oflaxacin drops and flonase. (all for 10 days)

    When I went to see the ENT days later, they added prednisone for 4 days, stating the middle ear infection was bad and it would assist with swelling. They did a test with a tuning fork on each side, plus on my teeth, stating it was normal and I wasn't favoring either side. The ENT stated that if there were still hearing loss in 2 weeks, we'd do a hearing test.

    Through this time I noticed no improvement in my hearing, while there was some reduction in ear ringing. At my followup appointment, the doctor noted "there is still a lot of fluid behind my drum" and that the eardrum hadn't fully healed. I did do an audio exam that was not normal from both an eardrum and nerve perspective (not sure if I'm using the right terms there, but both graphs tended away from normal). The doctor also did a test with an 'air puff' (he said to test the integrity of the eardrum). The bad ear showed a flat line on the graph (sorry if this doesn't make sense).

    The doctor prescribed Levaquin to be more aggressive with the infection. He stated that, although it appears bad, I wouldn't have to worry and normal hearing should return, with an outside "worse case scenario" of getting a hearing aid.

    The doctor seemed to indicate I should have noticed some improvement in hearing by now, but I'm not.

    Based on what the doctor said, perforations are a fairly common injury and should usually heal in a couple weeks.

    Neither of these seem to be what is going on with my case.

    Hence the reason for my posting, because what the doctor is saying he expects to happen isn't happening.

    What is a normal expectation for return of hearing in a case like mine? Do perforations ever take longer than 2-3 weeks to heal? Does something as simple as a perforation and/or middle ear infection ever cause permanent hearing loss?

    Some miscellaneous notes (in the interest of full disclosure):
    I am a music lover and concert goer. Other than a few times in my teen years, I have always worn earplugs at concerts and I haven't felt any hearing loss in all my years of listening to live music.

    I have no pain at all, just feels like pressure and feeling "stuffed up" in the affected ear.

    Never had any major health issues outside of this. Never had any major ear infections like this one.

    Thanks in advance to anyone who replies.
    Rod Moser, PA, PhD responded:
    It would not be possible for me to predict how long it will take your hearing to return. I do not know the extent of your rupture, the location of your rupture on the eardrum, or the severity of your infection. Healing is such an individual process, it is difficult for any medical provider to accurately predict outcome. Yes, it can take longer than 3 weeks.

    Yes, the vast majority of eardrums heal in a few weeks....and in some cases, a few months. A few do not heal at all and may need to be surgically patched.. The spontaneous ruptures (from infections) can be more extensive and take longer to heal. Most people will eventually have a complete restoration of their former hearing levels. Again, it is not possible to know when this might happen.

    You are a LONG way from that worst case scenerio and those hearing aids, so hang in there. The body has a remarkable ability to heal itself given sufficient time. I suspect that you are doing everything that can be done to expedite this process, but is still takes time.
    SteveYYZ replied to Rod Moser, PA, PhD's response:
    Thank you for your reply.

    I do understand it's next to impossible to diagnose over the internet, but insofar as expectations, you did answer and I appreciate that. I was starting to get worried because the ENT seemed to indicate this was a 2-3 week fix.

    I don't have any specifics to the perforation's location or severity, but I do know that as of last Thursday it still hadn't healed (17 days at that point). As for the infection, the ENT asked a couple of times, "Have you ever had a bad infection like this"? I realize that isn't much to go on, and the ENT did indicate that the initial use of Amox-Clav Oflaxacin Flonase Prednisone didn't do the trick because he said there was still "a lot of fluid" in my middle ear. Maybe it IS a worse than normal infection.

    As I mentioned above, he decided to put me on Levaquin (which he described as a stronger antibacterial medication) plus continued use of flonase.

    For what it's worth, I think there may have been minor improvement in my hearing over the past few weeks. This is not a scientific test by any means, but that first week I couldn't even hear my phone when it was up to my bad ear. The other day I was able to carry on a conversation (via phone) through that ear, only asking the person to repeat a couple of times. So, maybe some improvement, but I could be imagining it too.

    Another oddity: A couple of different times, my left ear would "pop" for 10-15 seconds. One instance last week in particular, this happened twice within a minute. For approximately an hour or so, I felt like I could hear a lot better. I work in IT in an office setting and there is ambient noise (heating vents, etc), and yet I could hear someone talking across the room. Later that day, the hearing wasn't as good. I'm wondering if the fluid in that ear is playing tricks on me.

    The ENT did say the sound most likely indicates fluid is draining and this is a good thing. Is there any truth to that?

    For the past couple of days, 2-4 times per day, I noticed these instances of popping for 10-15 seconds. I still feel a good deal of pressure (but little to no pain). Just an odd sensation really...

    Anyways, you did reassure me a bit that this might just take some time. When the ENT said that 2-3 weeks was the norm, and I didn't notice any progress, I guess I started to panic a bit.

    Thank you for this and any future replies. I do have another followup on Jan 6th (after Levaquin runs out) so I may revisit this post at that time. Hope the new year finds you well.
    Rod Moser, PA, PhD replied to SteveYYZ's response:
    You will know more after your ENT follow-up examination. It may even heal by that time, but you could still have residual fluid. Your ear will try to equalize pressure via the Eustachian tubes, so that "pop" is really what is most likely happening.
    AnandShanbhag replied to SteveYYZ's response:
    Hi Steve,

    Coincidently, even I am suffering from exactly same problem from 15 days. The only difference is that my hearing is not so bad from my bad (right) ear, but i hear my voice very loudly. If i kept my mouth shut then things are not that bad.

    Here are the details of my condition;
    1. I have a small perforation in my right ear drum.
    2. This perforation was the result of Ear infection in my middle ear.
    3. I feel something is choked/filled inside my right ear.
    4. I have no pain in my bad ear.

    I have visited ENT two weeks back, and she has prescribed few antiboitics, Sinerest nose drops and BetaMethasone and Neomycin ear drops (from GSK) for a period of 1 week.
    I haven't seen any progress though.

    For my second week, ENT has prescribed L Montis tablet/capsules for 1 week.

    My next appointment is on 5th January '10. Hope there will be some progress till that time. Even i am really worried of my condition. :s

    My ENT has told me that it will take 2 Months to recover from this. ENT has also advised me to stay away from cold drinks and any thing which may cause cold and cough to me.

    Could anyone please let me know whether i am going through right medication or not.

    Steve, could you please keep updating your progress to me. I will do the same thing.

    katers2717 replied to SteveYYZ's response:
    Hi there-

    I'm in the same boat and also starting to get worried. I had an ear infection in both (middle) ears that caused the eardrums to rupture and also caused drainage.

    I currently have major hearing loss in both ears. I'm only on week 1 of the hearing loss and I'm wondering what your condition is at this point? I see this was posted a year ago, but if you have time I'd greatly appreciate your feedback.

    Thank you so much,
    Rod Moser, PA, PhD replied to katers2717's response:
    Kate....depending how large the ruptures are, and the location on the rupture on the eardrum, it can take a several weeks before your eardrum is sufficient healed before your hearing will return to its normal level of acuity. Make sure to have a follow up appt in about a month with your primary care medical provider or an ENT to make sure that all is well.

    Hang in there. A ruptured eardrum from a middle ear infection is Nature's Way of dealing with the painful pressure. The vast majority of ruptured eardrums heal without any complications or residual hearing loss.
    SteveYYZ replied to katers2717's response:
    Hi guys!

    I had forgotten about this posting.

    In any event, the infection cleared and the eardrum healed after about 10 weeks or so. My tinnitus is still there a year later. After about six months, I had no hearing improvement, so the doctor sent me in for a brain MRI. It came back negative.

    I definitely had improvement in hearing after the ear drum healing, but my hearing didn't quite get back to normal. I have been doing periodic audio exams and only this past January (just over the 1 year mark) did I show some improvement. It's odd to me that the improvement only started after that time. Having said that, the hearing loss is minimal (4000 Hz-8000 Hz range, maybe Dr Moser can clarify how bad that is).

    I've been using Flonase the entire year, as my ENT's discretion. The thinking (per the doctor) is that if the swelling stays down by the eustachian tubes, that I will be less prone to infection.

    On that note, in early February I did get a really bad infection, very similar to the one I got when my eardrum first perforated in late 2010. My ENT said to take these more seriously (due to previous perforation), so I went right in and they gave me some antibiotics. Despite my best efforts (using flonase religiously), he said I could still be prone to these bad infections for up to 5 years.

    So in summation...I have a very minute bit of hearing loss all this time later. After the perforation healed, I was mostly back to 'normal' hearing but per the audio exams there is still a bit of loss. I did show an improvement in an audio exam only a few months ago, but I'm still not at the "normal" plateau. I do have a bit of tinnitus that goes from not bad to annoying at times. I don't think it will ever really go away but I've learned to either ignore it or use 'white noise' at night when trying to sleep.

    Anyways, I know firsthand how frustrating it is to be without the hearing. The doctor's reply to me above is does take time and won't always heal within a few weeks. From my experience, it was important to follow the prescription regimen to cure the infection...and for the eardrum, just give it time and be patient.

    Rod Moser, PA, PhD replied to SteveYYZ's response:
    Thanks for your helpful comments, Steve. Your hearing loss is not too terrible, as you know. I assume you are quite functional, but sometimes we lament over the small fracture was lost; not be pleased with the hearing that remained. You most likely still have ETD, setting you up for periodic middle ear infections. You may have some residual middle ear fluid, even if it is not obvious on a routine exam.

    Still on the Flonase, for sure.
    EarRing replied to SteveYYZ's response:
    Hey Steve,

    did the tinnitus ever go away?
    EarRing responded:
    Steve situation was pretty much like mine two years ago,huh doc? can't believe he still have the tinnitus..funny how one ear infection can change a person's life.
    SteveYYZ replied to EarRing's response:
    It's over 2 years later.

    I have a mild hearing loss (4000Hz-8000Hz range, as I posted above)...and persistent tinnitus. It ranges from not noticable to mildly annoying. I try to drown it out with white noise; I run a fan even in the winter weather. My ENT even gave me a diet to follow that helps mitigate the ringing in some had no meaningful effect on my situation however...

    The biggest thing with tinnitus is that you have to train yourself to not pay attention to it. I know that sounds vague (maybe Dr Moser can clarify)...but it's really the truth. I'm not immune to the effects of what happened...there are times in a noisy restaurant that I have to ask people to repeat themselves...but nothing to an absurd degree. For the most part I function pretty normally on a day-to-day basis.

    EarRing replied to SteveYYZ's response:
    Thanks for the reply, Steve!

    best to you.
    Jessea85 replied to EarRing's response:
    Hi guys,

    Steve, firstly I feel your pain! Last year in October, out of no where, I got a really bad ear infection. I was in so much pain for 2 months until my ear drum burst. I had seen countless doctors who prescibed me antibiotics and ear drops. I had my ear washed out 3 times and it would get better for about a day and then go back to presuure pain, clogging feeling, hearing loss - all of the symptoms you have described. My doctor ensured me it would be better by the time I was flying to Europe from Australia in December, but alas, it did not heal. I saw another doctor before I left and he said I had a staph infection. He prescribed me different antibiotics for 2 weeks and said I should be ok to fly considering my ear drum had already burst. I was fine flying, no pain at all.

    I was overseas for 6 weeks and had the same popping noise for 10-15 seconds where I felt like I had super hearing! but then it would go back to hardly hearing anything. I returned to Australia last week and the popping has stopped and I can't hear people talking on the phone out of that ear. It is constantly ringing. I am off to the doctors again today and will get a refferral to see an E&T Specialist.

    Right now, my ear just feels fulls with constant ringing. I try and clean it out with a tissue and salty water and sometimes 'gunk' comes out of it which is browny, watery sometimes has pus in it?

    I too, can't believe how 1 ear infection has done so much damage. I pray that my hearing returns! Will keep you posted on my progress.
    GemmaAbbey21 replied to Jessea85's response:

    I have the same problem here. Just curious as to how you guys got on?

    Please let me know!

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